19 November 2009

As you are probably aware, Harry Reid released the Senate's version of the merged health care bill yesterday. I don't think I can add much to what has been said elsewhere, so I'll spare you the painful rehashing of the details. You're welcome.

There's a lot of comments that could be made about this bill. It's nice to see that it's fiscally responsible. It's not only deficit-neutral, but it actually pays down the deficit by $127 billion. Not too shabby. Of course it does that by deferring the best benefits of the bill to 2014. That's not too great, especially because there is going to be an election between here and then. If the health reform has been on the books for five years and has not done much to improve access to health care (which it will not have until the exchanges open in 2014) there's a very strong chance that the voters will punish the Democrats for broken promises. I understand that this compromise was necessary to make the bill affordable and get it passed, but it may have been a very bad decision strategically for the Democrats.

The thing that I think is striking was that in the face of an explicit filibuster threat from Lieberman, and open waffling from the ConservaDems, Reid kept the opt-out Public Option in the bill. I was quite expecting it to be thrown on the sacrificial altar, and it's so watered down and minimized that I was more or less resigned to it. Moreover, Reid had a private chat with Nelson, Lincoln, and Landrieu in which he discussed, among other things, moving the bill to the floor using the non-filibusterable reconciliation process. It wasn't couched as a threat, but the message was clear: block this and we will bypass you and make you irrelevant. Does he have a secret plan to get health care through reconciliation intact? I haven't got a lot of faith in Reid, and I won't be surprised if he buckles, but I like his positioning at this point.

2 comments:

I disagree that Reid is in a good position (at least to pass the bill through the regular senate process). The House bill barely passed with 30 democrats voting AGAINST the bill. There's got to be a lot of things going right for the senate Dems to pass this bill in the more conservative senate. Not only that, I get the feeling that the American public is becoming dissatisfied with this issue. With unemployment continuing to increase and with this "jobless recovery" people just want to get back to work. Less than half of Americans approve of Obama's job performance.

As far of fiscally responsible... well I guess this is more fiscally responsible than normal but do you really believe that this bill is going to decrease the debt by $127 billion? The CBO score sheet hasn't even been released yet and Reid is already touting these numbers. Medicare was "supposed" to be sustainable and now it's going to go insolvent in a couple of years.

And the public health plan. The CBO estimates that only 1% of the population is going to enroll. The major decrease in the number of uninsured will happen through the enrollment of Medicaid. It's much more of a symbolic gesture than anything. Or worse, it's just the first step to a national health care. You get a small number of people dependent on the public option, then when the people want more of it, you increase the size of the option. Then the ball rolls.

There's definitely going to be a lot of unintended consequences resulting from these bills.

Shadowfax

About me: I am an ER physician and administrator living in the Pacific Northwest. I live with my wife and four kids. Various other interests include Shorin-ryu karate, general aviation, Irish music, Apple computers, and progressive politics. My kids do their best to ensure that I have little time to pursue these hobbies.

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